Medically reviewed by, Russell Braun RPH
We have all been there, feeling the scratch in the back of your throat. You cough and cough but that sensation won’t go away. The coughing makes your throat hurt worse. It seems like there is no end in sight. Could benzonatate help your sore throat?
What choices do you have?
Doctors may choose benzonatate, pronounced (ben-ZOE-na-tate) for sore throat. The drug is also known by the brand name Tessalon Perles. Benzonatate is available by prescription only.
It is a popular option because it is a non-narcotic medication to help suppress cough. Due to the recent opiod crisis, doctors are looking for options that are non-narcotic all the time.
1. How often is Benzonatate used?
Benzonatate has been around since the late 1950’s. It is chemically similar to drugs called anesthetics used to numb nerves in the body. In 2017 there were over 4.3 million prescriptions filled for benzonatate. The non-narcotic designation has probably helped to drive a surge in benzonatate usage.
2. Common causes of sore throat
Several triggers of the cough reflex can lead to a sore throat. Most of them cause a post nasal drip while others irritate the throat directly.
Strep throat is the most common cause of bacterial sore throat. It is called strep throat because the species responsible. It referred to as Streptococcus, which also can be highly contagious. Benzonatate is not going to relieve a sore throat from strep unless there is coughing in addition to throat pain.
|Dry air||Tobacco smoke|
|Gastroesophageal Reflux Disease (GERD)||Tumors|
|Asthma||Chronic Obstructive Pulmonary Disease (COPD)|
|Congestive Heart Failure (CHF)|
Talking too much or repeated yelling can cause irritation in the throat. As a result these muscles can actually become strained. Consequently, this could lead to sore throat and coughing.
3. Will Benzonatate (Tessalon Perles) help a sore throat?
First of all, Benzonatate, aka Tessalon Perles are not actually approved by the Food and Drug Administration (FDA) for sore throat. Rather, it’s approval is for relief of coughing. Consequently, stopping persistent cough provides relief in throat pain, which can become irritated from coughing.
Check out 9 Tips to Remember When Looking for Tessalon Perles Over the Counter to decide if you really need Benzonatate.
4. What is benzonatate used to treat?
Benzonatate is FDA approved to provide symptomatic relief of cough. Many different conditions can also cause coughing. Therefore, benzonatate used for a wide variety of problems that can lead to coughing. Some examples include:
- Common cold
How does Benzonatate work?
As mentioned above benzonatate is chemically similar to anesthetic drugs. Hence, it works to numb receptors in respiratory passages called stretch receptors. These receptors are found in the following areas:
- Pleura (a membrane that surrounds and protects the lungs)
When the stretch receptors are activated the brain induces a cough response in order to try and remove the offending agent that has triggered the stretch receptors.
Benzonatate numbs these receptors which also prevents the impulse to cough from being sent to the brain.
When is benzonatate not used?
Coughing is a defense mechanism the body uses to remove things from the airway and lungs. For that reason stopping the cough is not always a good idea. This is the case when a large amount of phlegm is being produced and coughing helps to bring it back up out of the airway.
5. Will Benzonatate cure a sore throat?
Benzonatate helps reduce coughing and in doing so lessens soreness of the throat. However, that is not necessarily treating the underlying condition. Treating the problem that is causing the coughing is the real way to cure a sore throat. As noted above there are many possible causes. Above all treating the underlying cause should be discussed with your doctor.
6. What is the correct benzonatate dose?
As mentioned before, benzonatate is only available with a prescription. Therefore, patients should follow their doctors instructions for how to take. The manufacturer recommends a starting dose, but in some cases the doctor may want to give a higher dosage based on the cause of the cough.
Normal starting dose:
Adults and children 10 years and older
- 100mg by mouth three times a day
- 200mg per dose or
- 600mg per day
Dosing is often as needed, meaning it can be taken every 8 hours or skip a dose if coughing is not as bad at a certain point during the day.
7. Key points on using Benzonatate
- Swallow capsules whole, do not cut or crush.
- Chewing, or sucking on the capsules can result in numbing of the mouth or throat.
- To prevent choking, avoid eating or drinking until numbness goes away.
8. How long does it take for benzonatate to take effect?
Benzonatate comes in liquid filled capsules that are called perles. As a result, they dissolve quickly after being swallowed. Therefore, it normally only takes 15 to 20 minutes to see effects from benzonatate.
The effects normally last between 4 to 8 hours, which is why it is typically prescribed three times per day. Allowing 8 hours between doses provides relief of coughing for most patients.
9. Over the counter options
Benzonatate and opiod containing cough suppressants require a prescription from your doctor. In contrast, there are Over The Counter (OTC) options for treating sore throat.
The only option that rivals benzonatate are cough suppressants, sometimes also called antitussives. They would also alleviate throat pain by preventing cough. Consequently, if Benzonatate is not eliminating your cough completely, ask your doctor if you could use an OTC option as well. They work in different ways and therefore may be more effective than either one alone. Examples of these OTC cough suppressants include:
- Dextromethorphan (Deslym, Robitussin)
- Camphor (Cemphire)
- Eucalyptus oil (doTerra)
- Menthol (Chloraseptic & various other products)
Similarly, other OTC’s for general cold symptoms include decongestants and expectorants. Decongestants cause constriction of blood vessels, which also decreases secretions that can cause a cough. Expectorants can help to thin mucous that causes coughing due to post nasal drip. When the mucous is thinned it is easier to expel when you cough.
- Phenylephrine (Sudafed)
- Oxymetolazine (Afrin)
- Guaifenesin (Mucinex)
Some online resources will also recommend antihistamines. However, these can make symptoms worse due to anticholernergic side effects. The only time they are helpful is when patients have trouble getting to sleep. Common examples of OTC antihistamines include:
- Brompheniramine (Dimetane)
- Diphenhydramine (Benadryl)
- Chlorpheneramine (Chlor-Trimenton)
- Cetirizine (Zyrtec)
- Fexofenadine (Allegra)
- Loratadine (Claritin)
10. Does Benzonatate make you sleepy?
Benzonatate has been shown to cause drowsiness. In fact, it is the first side effect listed in the prescribing package insert the FDA requires. Drowsiness could also be viewed as a positive effect. Many patients with sore throat often need to be able to get sleep in order to heal.
That is why often it will be prescribed as needed. Therefore, patients can take the medication at night to sleep. Then decide if they should take it or not based on the activity they have during the day. The amount of coughing they are experiencing without the medication can also help them decide.
11. Drug interactions and side effects
Benzonatate can interact with certain medications that may also cause drowsiness. Therefore, the risk of drowsiness increases more than with either drug alone. For people with sore throat a good sleep will almost always be refreshing. However, this is important to remember if planning on operating machinery, driving a car or other activity that requires alertness.
The table below lists some examples of drugs that could cause additive drowsiness with benzonatate. This is not an all inclusive list.
|Antihistamines||Benadryl, Dramamine, Zyrtec|
|Anti-seizure||Tegretol, Dilantin, Depakote, Neurontin, Lyrica, Topamax, Keppra|
|Sleep aides||Ambien, Sonata, Rozerem, Lunesta|
|Anxiety medications||Xanax, Valium, Klonopin|
|Muscle relaxers||Soma, Flexeril|
|Narcotic pain relievers||Hydrocodone, Oxycodone, Codeine|
|Psychiatric medication||Chlorpromazine, Risperidone, Elavil, Trazodone|
|Herbal products||Kava, St, John’s Wort, Melatonin, Valerian Root, Lavender|
Common side effects of benzonatate include:
Central nervous system
- Mental confusion
- Stomach upset
- Skin eruptions
- Hypersensitivity reaction, such as bronchospasms
- Numbness or tingling in mouth
- Nasal congestion
- Numbness in the chest
- Burning in eyes
12. Benzonatate is dangerous for children
Children under 10 years of age should not use benzonatate. The FDA has issued a warning that use in younger children can result in death from overdose. The warning was based on cases where children were attracted to the perles and though they were candy. The round shaped liquid filled capsules called a perle should be kept away from children.
Overdoses can result in tremors, convulsions, coma and cardiac arrest. Below are some recommendations from the FDA on safe storage of benzonatate.
- Keep in child-resistant container.
- Store out of reach of children at all times.
- Dispose of leftover perles in the trash in a sealed bag or can.
- Poison control should be contacted immediately if ingestion is suspected.
13. Final thoughts on benzonatate
Coughing that leads to sore throat can severely impact quality of life. Everything from disrupting work, personal schedules and sleep can be stressful. Benzonatate offers an option for suppressing cough and allowing the throat to heal.
Most prescription cough suppressants are narcotics containing opioids. These drugs suppress the cough reflex but also suppress respiratory drive. When people overdose on opioids the respiratory depression is what causes death. Benzonatate does not suppress the respiratory centers in the brain.
Ultimately, the doctor prescribing the cough suppressant should weigh the pros and cons of benzonatate. Patients should clearly understanding the risks and benefits and make a shared decision on treatment.
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